Approved by: Oxygen Delivery Gail Cameron Senior Director Operations, Maternal, Neonatal & Child Health Programs Dr. Paul Byrne Medical Director, Neonatology Neonatal Policy & Procedures Manual Policy Group: Respiratory Date Effective Next Review October 2018 Dr. Sharif Shaik Medical Director, Neonatology Purpose Policy Statement Applicability To provide guidelines for delivery of supplemental oxygen to neonates in the Neonatal Nursery. Supplemental oxygen is a drug with life sustaining potential and potential toxicities. Many newborn diseases create situations where supplemental oxygen is required; however, newborns have reduced anti-oxidant defences and underdeveloped central nervous, respiratory and haematological systems that are prone to oxidative stress. Prolonged low oxygen saturations are associated with poorer survival, more complicated clinical courses and poorer neurodevelopmental outcomes. Side effects of oxygen administration seem to be related to high oxygen levels, rapid & wide changes in oxygenation, sustained hyperoxemia, and episodes of hypoxemia. This situation requires careful attention to oxygen administration to maintain a balance between sufficient oxygen levels and risk of deleterious side effects. All Covenant Health employees in the Neonatal Nursery. Principles Unless given in an emergency, oxygen administration requires an order. Use of oxygen in the delivery room follows guidelines established by Canadian Neonatal Resuscitation Steering Committee. Except during resuscitation, all administered oxygen is humidified Administer oxygen via a heated humidified system unless given by low-flow cannula, bag or T-piece resuscitator. Unless given by low flow cannula, administered oxygen concentration is titrated with a blended source. Blender accuracy is verified utilizing an oxygen analyzer. All infants receiving oxygen are monitored by pulse oximetry according to Non-Invasive Monitoring Policy Pulse oximetry limits are ordered by physician or NNP on the patient care orders with a specified COD profile or ordered upper and lower limits. Adjustment of oxygen for NICU patients will follow the attached COD algorithm.
Oxygen Delivery Policy No. Page 3 of 5 Monitor Setting Premie NO device Premie on resp device Term NO device Term on resp device Extended Cardiac Car Seat Defining Characteristics 36 +6 36 +6 Not on O 2 37wk 37wk on O 2 Labile SpO 2 (ie. PDA,CLD) Individualized Car Seat SpO 2 Alarm Limit 88-100 88-93 92-100 92-97 88-95 75-85 or as ordered 88-100 High & Low SpO 2 Delay Time 30 Sec 30 Sec 30 Sec 30 Sec 30 Sec 30 Sec 10 sec * low SpO2 only Minimum SpO 2 82 82 82 82 82 75 or as ordered Red alarm only for SpO2 <88. Minimum SpO 2 Delay time H: 0 Sec 0 Sec 0 Sec 0 Sec 10 Sec 0 Sec This is a significant event L: Please use a bubble (along with a fish) for all patients that require individualized SpO2 settings as determined by the multidisciplinary team during rounds. Averaging time for All Profiles = 10 seconds Definitions: SpO2 Alarm Limit Above or below this limit alarm will sound after delay time is reached. High & Low SpO2 Delay Time 30 seconds SpO2 must be above or below the limit for 30 seconds Minimum SpO2 Delay Time 0 seconds When SpO2 drops below this level a red alarm occurs immediately. For Extended and Car Seat profile only 10 second delay. Averaging Time 10 seconds SpO2 is averaged over 10 seconds and then displayed on the monitor. The display is updated with every beat.
Oxygen Delivery Policy No. Page 4 of 5 Related Documents Non-invasive monitoring. Neonatal Resuscitation in the Delivery Room Assisted Ventilation Care of Infant References Adapted with permission from Stollery Children s Policy and Procedure Manual: http://insite.albertahealthservices.ca/assets/policy/clp-capital-nicu-pp-respiratory-oxygenadmin-pol.pdf Oxygen Administration July 2012 Revisions October 2012
Signing GAIL CAMERON SENIOR DIRECTOR OPERATIONS MATERNAL, NEONATAL & CHILD HEALTH PROGRAMS GREY NUNS & MISERCORDIA HOSPITALS DR. PAUL BYRNE MEDICAL DIRECTOR NEONATAL PROGRAM GREY NUNS HOSPITAL DR. SHARIF SHAIK MEDICAL DIRECTOR NEONATAL PROGRAM MISERICORDIA HOSPITAL